J Cancer 2021; 12(3):927-935. doi:10.7150/jca.52299

Research Paper

A novel prognosis marker based on combined preoperative carcinoembryonic antigen and systemic inflammatory response for resectable gastric cancer

Yubin Ma1#, Junpeng Lin2#, Jianxian Lin2#, Junfang Hou1, Qin Xiao1, Fang Yu1, Zhijun Ma1, Ping Li2, Ruhong Tu2, Jianwei Xie2, Chaohui Zheng2, Su Yan1✉, Changming Huang2✉

1. Department of Gastrointestinal Oncology, Qinghai University Affiliated Hospital, Xining, People's Republic of China.
2. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China.
#Co-first authors with equal contributions to this work.

This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Ma Y, Lin J, Lin J, Hou J, Xiao Q, Yu F, Ma Z, Li P, Tu R, Xie J, Zheng C, Yan S, Huang C. A novel prognosis marker based on combined preoperative carcinoembryonic antigen and systemic inflammatory response for resectable gastric cancer. J Cancer 2021; 12(3):927-935. doi:10.7150/jca.52299. Available from https://www.jcancer.org/v12p0927.htm

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Background: Carcinoembryonic antigen (CEA) is one of the important indexes for the diagnosis and prognosis of gastrointestinal cancer. Systemic inflammatory response (SIR) is closely related to the occurrence and development of gastrointestinal cancer.

Methods: A total of 803 patients who underwent radical gastrectomy in Qinghai University Affiliated Hospital from January 2012 to December 2016 were included as training set. Multivariable Cox proportional hazard regression was used to identify associations with outcome of gastric cancer (GC). CNLR was established by combining CEA and the neutrophils to lymphocytes ratio (NLR, a typical parameter in SIR) to generate a novel prognostic score system and its prognostic value was externally validated.

Results: Multivariate analysis showed that CEA and NLR were independent prognostic factors for GC patients (both p < 0.05). A higher CNLR was significantly associated with older age, male sex, larger tumor size, vascular invasion and advanced stages (all p < 0.05). Patients with higher CNLR had poor prognosis than those with lower CNLR (p < 0.05). Multivariate analysis showed that CNLR was an independent prognostic factor (p < 0.05). Incorporation of the CNLR into a prognostic model including age and TNM stage generated a nomogram, which predicted accurately 3- and 5-year survival for GC patients. And similar results were obtained in the external validation set.

Conclusions: The CNLR prognostic scoring system established by combining CEA and NLR is an independent prognostic factor for GC, which can be incorporated into the traditional TNM staging to improve the prediction of long-term survival outcomes.

Keywords: gastric cancer, carcinoembryonic antigen, systemic inflammatory response, nomogram, prognosis